Heart Failure: Roles of Different Doctors

One of the most important decisions you will make after
you have been diagnosed with
heart failure is whom you choose to be your doctor.
Your doctor will confirm the diagnosis and design a treatment plan for your
heart failure and will be responsible for monitoring the progression of the
disease and the effectiveness of the treatments. It is very important that you
choose a doctor who is qualified to manage your heart failure. It is also
important that you have a doctor with whom you feel comfortable sharing
information about your symptoms and experiences.

What types of doctors can treat heart failure? All medical
doctors have some knowledge about how to diagnose and treat heart failure.
Doctors who treat people with heart failure include:

General practitioners (GPs) and family medicine physicians (FMPs), who have a working knowledge of the
entire human body and the diseases that affect it. They treat a variety of
people, including children, adolescents, and adults. GPs and FMPs usually work
in outpatient clinics or their own offices and not usually in hospitals. At
first a GP or an FMP may diagnose and treat your heart failure. But for more
serious and complicated heart failure, your GP or FMP may start treating you
and then refer you to a specialist who may be more qualified to treat your
condition.

Internists. Your primary care doctor may
also be an internal medicine doctor (internist). An internist has completed
several years of advanced training in the medical management of diseases that
affect all of the organs of the body. Unlike GPs who often treat children and
adolescents, internists usually limit their practices to adults. If the doctor
you regularly visit is an internist, he or she may supervise your treatment
after referring you to a cardiologist for specialized testing. An internist is
qualified to manage the treatment of mild to moderately severe forms of heart
failure and may do so just as successfully as a cardiologist.

Cardiologists, who specialize in diseases that affect the
heart and blood vessels. Cardiologists first train to be internists and then do
several more years of training in cardiovascular disease. This additional
training qualifies them to manage and treat diseases such as heart failure,
coronary artery disease (CAD), and high blood pressure (hypertension). As your
heart failure progresses, a cardiologist will probably play a large role in
your treatment. After a diagnostic consultation, your cardiologist will discuss
your care with your primary care doctor. In some cases your doctor will ask the
cardiologist to confirm the diagnosis and the treatment plan but then will
continue to take care of your heart failure. If heart failure is more severe or
complex, you might continue to see your usual doctor for general medical care
but see a cardiologist regularly for care of your heart.

Cardiac Electrophysiologist. If you have a heart rhythm problem or need a cardiac device, you might see a cardiac electrophysiologist. Electrophysiologists are cardiologists who specialize in diagnosing and treating heart rhythm problems (arrhythmias). They can implant devices such as pacemakers and ICDs (implantable cardioverter-defibrillators).

Heart failure specialists. Certain cardiologists
specialize in heart failure. In addition to their training in general
cardiology, these doctors have received specialized training in taking care of
people with advanced heart failure and people who require or have received
heart transplants. As heart failure gets worse, your general cardiologist may
refer you to one of these subspecialists. Heart failure specialists usually are
familiar with and have access to the most advanced therapies for heart failure,
including experimental treatments.

Cardiac surgeons. If your cardiologist decides that you need
surgery, he or she will refer you to a cardiac surgeon. Cardiac
surgeons can specialize in many different types of heart surgery, such as
coronary artery bypass graft (CABG) surgery or heart transplant. Cardiac
surgeons can also repair or replace faulty heart valves. You generally will see
a cardiac surgeon for a relatively brief period of time before and after the
operation and will continue to see your cardiologist and your primary care
doctor for your ongoing care.

In the treatment of heart failure, there will be a
relationship between your primary care doctor and the doctors who specialize in
treating your heart (specialists). Each type of doctor has a unique set of
skills and may play a specific role in the management of your disease. Your
initial tests to diagnose heart failure will probably be ordered by a primary
care doctor, but some of these tests may need to be performed or interpreted by
a cardiologist. Your primary care doctor may be a general practitioner.

Which type of doctor is the best for you?
Internists and cardiologists are the two most common types of doctors
responsible for treating heart failure. Cardiologists usually focus on treating
people with more severe forms of the disease. The needs of each person with
heart failure are different based on factors such as the cause of heart
failure, the severity of the disease, and the age of the person. Recently there
have been a number of studies that compare how well internists manage heart
failure treatments compared with cardiologists. Some evidence suggests that
cardiologists may achieve better outcomes in treating heart failure.

Is a cardiologist best for you? Cardiologists specialize in heart diseases. They have had extra
training on managing and treating diseases such as heart failure, coronary
artery disease (CAD), and high blood pressure (hypertension).

Is an internist best for you? On the other hand, there may be
some advantages in going to an internist to treat heart failure. First, your
internist is likely to always be more familiar with the details of your medical
history because he or she has managed each of your medical problems over the
years. Second, you may feel more comfortable with your primary doctor because
of this long-term relationship and therefore you may be able to work together
more efficiently and productively. Third, if you see your internist for all of
your care, he or she may be better able to optimize and balance the treatment
of all of your medical problems, not just heart failure.

What other types of doctors treat heart failure? In recent years, many physician practices have employed nurse
practitioners (NPs) and physician assistants (PAs) to help in the care of
people with heart failure. These professionals have had advanced training in many
aspects of general medicine. They extend the level of care a doctor can provide,
because they can evaluate and treat many of the routine problems that arise in
people who have heart failure. When more complex decision-making is required or
when the severity or complexity of the problems surpasses the usual, NPs and
PAs then can consult with the heart failure specialist.

When is a cardiologist referral needed? Your primary care
doctor will usually decide whether to refer you to a cardiologist for treatment
of your heart failure. Most doctors agree that there are certain situations
when people with heart failure should always be referred to a cardiologist. In
these situations, the complexity of the heart failure requires a specialist's
knowledge and attention.

If you fit into one of the categories
below and your primary care doctor has not referred you to a cardiologist, you
should discuss the possibility of a referral to a cardiologist. As heart
failure progresses and approaches end-stage, some people should be seen by a
heart failure specialist. Usually your general cardiologist will refer you, but
your general physician may do so.

People who should usually be seen by a cardiologist include those with:

Severe heart failure (class III or
IV).

Severely weakened hearts from heart failure (ejection
fractions of less than 30%).

Moderate or severe heart failure
caused by coronary artery disease.

Heart failure caused by heart
valve conditions.

Heart failure that is complicated by arrhythmias
(especially ventricular tachycardia).

Heart failure symptoms that
are worse despite treatment by a primary care physician.

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